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Follow up Care for Children Prescribed ADHD Medication

EHP, Priority Partners, and USFHP. Members between 6 and 12 years of age.

Measure evaluates the percentage of members 6-12 years of age with newly prescribed attention-deficit/hyperactivity disorder (ADHD) medication who had at least three follow up care visits within a 10-month period. One visit is required within 30 days of when the first ADHD medication was dispensed. Two rates are reported.

  • Initiation Phase: percentage of members 6-12 years of age as of the IPSD (Index Prescription Start Date) with an ambulatory prescription dispensed for ADHD medication, who had one follow-up visit with practitioner with prescribing authority during the 30-day Initiation Phase.
  • Continuation and Maintenance (C&M) Phase: percentage of members 6-12 years of age with an ambulatory prescription dispensed for ADHD medication, who remained on the medication for at least 210 days and who, in addition to the visit in the Initiation Phase, had at least two follow-up visits with a practitioner within 270 days (9 months) after the Initiation Phase.

Best Practice and Measure Tips

Timing of scheduled visits is key based on the prescription day supply to evaluate medication effectiveness, any adverse effects and to monitor the patient’s progress.

When prescribing a new ADHD medication for a patient:

  • Schedule follow-up visits to occur before the refill is given.
  • Schedule a 30-day, 60-day and 180-day follow-up visit from the initial visit before member leaves office.
  • Consider scheduling follow-up visit within 14 to 21 days of each prescription.
  • Consider prescribing an initial two-week supply and follow-up prescriptions to a 30-day supply to ensure patient follow-up.

Only one of the two visits (during days 31–300) may be an e-visit or virtual check-in.

ADHD Medications

CNS stimulants:

  • Amphetaminedextroamphetamine
  • Dexmethylphenidate
  • Dextroamphetamine
  • Lisdexamfetamine
  • Methylphenidate
  • Methamphetamine
  • Alpha-2 receptor agonists
  • Clonidine
  • Guanfacine
  • Miscellaneous ADHD medications
  • Atomoxetine

Measure Exclusions

Required Exclusions:

  • Hospice
  • Patients who filled an ADHD prescription 120 days (4 months) prior to the IPSD (Index Prescription Start Date). Applies to only Rate 1 – Initiation phase.
  • Patients who had an acute inpatient encounter for a mental, behavioral or neurodevelopmental disorder during the 30 days after the IPSD.

Optional Exclusions: Members with a diagnosis of narcolepsy any time during their history through December 31 or the measurement year.

Narcolepsy Value Set:

  • [G47.411] Narcolepsy with cataplexy;
  • [G47.419] Narcolepsy without cataplexy;
  • [G47.421] Narcolepsy in conditions classified elsewhere with cataplexy;
  • [G47.429] Narcolepsy in conditions classified elsewhere without cataplexy.

Measure Codes

The following code combinations identify follow-up visits:

  • 90791, 90792, 90832–90834, 90836–90840, 90845, 90847, 90849, 90853, 90875, 90876, 99221–99223, 99231–99233, 99238, 99239, 99251–99255, 98960–98962, 99078, 99201–99205, 99211–99215, 99241–99245, 99341–99345, 99347–99350, 99381–99387, 99391–99397, 99401–99404, 99411, 99412, 99510, 99483, G0155, G0176, G0177, G0409, G0463, H0002,H0004, H0031, H0034, H0036, H0037, H0039, H0040, H2000, H2010, H2011, H2013, H2020, M0064, T1015.
  • An observation visit (observation value set) 99217–99220.
  • A health and behavior assessment/intervention 96150–96154.
  • Telehealth visit 98966–98968, 99441–99443.